NT-pro-BNP for diagnostic and prognostic evaluation in patients hospitalized for syncope
International Journal of Cardiology, 02/24/2012
Pfister R et al. – In patients hospitalized for syncope, NT–pro–BNP was a strong and independent diagnostic and prognostic marker and addition to conventional criteria of history and examination improved the discriminatory performance. Randomized trials must clarify the benefit and position of NT–pro–BNP in the management algorithm of patients with syncope.Methods
- NT–pro–BNP was assessed in 161 consecutive patients (median age 69years, 58% male) hospitalized for syncope in a cardiological university department and association (odds ratio: OR, 95% confidence interval: CI) with diagnosis of cardiac cause and 6–months outcome was analyzed.
- NT–pro–BNP levels were significantly higher in patients with cardiac (n=78) compared to non–cardiac syncope (n=83).
- At a cutoff of 156pg/ml, NT–pro–BNP showed a sensitivity of 89.7%, a specificity of 51.8% and a negative predictive value of 84.3% for the diagnosis of cardiac syncope.
- Increasing NT–pro–BNP was a significant predictor of cardiac syncope (OR 3.7, 95% CI 2.3–5.8 per standard deviation of Log NT–pro–BNP, p<0.001) and addition of NT–pro–BNP significantly improved a predictive model including heart rate, history of structural heart disease and abnormal ECG.
- Adding left–ventricular ejection fraction to the model did not change results.
- 63 patients had an adverse event during hospitalization or 6–months follow–up.
- NT–pro–BNP>156pg/ml significantly predicted an adverse outcome (OR 2.7, 95% CI 1.04–6.9, p=0.04) after multivariate adjustment.